07040070 7-77777777-"-7-7.7_777:777177 77.77,7777777777777.
CITY OF CUPERTINO
BUILDING DIVISION PERMIT � � ��ItEQRMTION
ri.
PERMIT NO.
""InAVYs4OMESTEAD RD #17G & 17H TBD - TJ BE DETERMINED 07040070
PERMIT ISSUE DATE
R'S NAME:
VILLA SERRA APARTMENTS 05/31/2007
SANITARY NO. CONTROL NO.
PHONE:
BUILDING PERMIT INFO
ARCHITECT/ENGINEER: BLDG ELECT PLUMB MECH
i p Q LICENSED CONTRACTOR'S DECLARATION Job Description
U P I hereby affirm that I am licensed under provisions of Chapter 9(commencing
Z w with Section 7000)of Division 3 of the Business and Professions Code,and my license is REPAIR & REPLACE DECK SURFACE & PLYWOOD MINOR
t<0- in full force and effect R Z Z STRUCTURAL-STARTED JOB W/OUT PERMIT-DOUBLE
�Z)z LieenscCl —L�,#
`$�ApRCH� rFCI'StDECLA ATIONL t FEES-CONTRACTOR PRO-CRAFT HAS BUS LIC #28938 .
i da
a 1 understand my plans shall be used as public records
)0.0
U.l- Licensed Professional
: a OWNER-BUILDER DECLARATION
�y
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
'0 O following reason.(Section 7031.5,Business and Professions Code:Any city or county
m which requires a permit to construct,alter,improve,demolish,or repair any structure
a' prior to its issuance.also requires the applicant for such permit to file a signed statement Valuation
Z r .Ft.Floor Area
a that he is licensed pursuant to the provisions of the Contractor's License Law(Chapter 9 �q $6600
4 t-a (commencing with Section 7000)of Division 3 of the Business and Professions Code)or
r3 that he is exempt therefrom and the basis for the alleged exemption.Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of 3260905 6 A9N Number Occupancy Type
not more than five hundred dollars($500).
❑1,as owner of the property,or my employees with wages as their sole compensation,
will do the work and the structure is not intended or offered for sale(Sec.7044,Business Required Inspections
and Professions Code:The Contractor's License Law does not apply to an owner of
property who builds or improves thereon,and who does such work himself or through his
own employees,provided that such improvements are not intended or offered for sale.If,
however,the building or improvement is sold within one year of completion,the owner-
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑1,as owner of the property,am exclusively contracting with licensed contractors to
construct the project(Sec.7044.Business and Professions Cade:)The Contractor's Li-
cense Law does not apply to an owner of property who builds or improves thereon,and.
who contracts for such projects with a contractor(s)licensed pursuant to the Contractor's
License Law.
F1 I am exempt under See. B&P C for this reason
r Date
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
❑i have and will maintain a Certificate of Consent to self-insure for Worker's Compen-
sation,as provided for by Section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑I have and will maintain Worker's Compensation Insurance,as required by Section
3700 of the Labor Code,for the performance of the work for which this permit is issued.
My Worker's Compensation insurance carrier and Policy number arc:
Carrier. k lEM'A l d Ff ISE PolicyNo.: l fl R 3 Z I&C
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars($100)
or less.)
i certify that in the performance of the work for which this permit is issued.I shall not
employ any person in any manner so as to become subject to the Workers'Compensation
Laws of California.Date
Applicant
NOTICE TO APPLICANT:If,after making this Certificate of Exemption,you should
become subject to the Worker's Compensation provisions of the Labor Code,you must
Oforthwith comply with such provisions or this permit shall be deemed revoked.
Z"' CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
p' the work for which this permit is issued(See.3097,Civ.C.)
LL)A Lender's Name
Z Lender's Address
U 0 1 certify that I have read this application and state that the above information is
LI r correct.I agree to comply with all city and county ordinances and state laws relating to
Ubuilding construction,and hereby authorize representatives of this city to enter upon the
U above-mentioned property for inspection purposes.
Q+ (We)agree to save,indemnify and keep harmless the City of Cupertino against
liabilities,judgments,costs and expenses which may in any way accrue against said City
U 2 in consequence of the granting of this permit. Date
APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by:
SOURCE REGULATIONS.
B.."XI ,SU S-'31 Re-roofs
Signature of Applicant/Contractor DateT ofF.00f
HAZARDOUS MATERIALS DISCLOSURE Type
Will the applicant or future building occupant store or handle hazardous material
'efrncd by the Cupertino Municipal Code.Chapter 9.12,and the Health and Safety
Section 25532(a)? All roofs shall be inspected prior to any roofing material being installed.
❑Yes lko
If a roof:s installed without first obtaining an inspection,I agree to remove
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management all new materials for inspection.
District?
❑Yes *0
I have read the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health&Safety Code,Sections 25505,25533 and 25534.1 understand that if the building
does not currently have a tenant.that it is my responsibility to notify the occupant of the
requirements which must be met prior to issuance of a Certificate of Occupancy. Signature of Applicant Date
1i`-'� ,S ^m All roof coverings to be Class"B"or better
(Owner or authorized agent Date
L Y VNUUYI!:1C1'11VO
BUILDING DIVISION PER*
STEAD RD #17G & 17H1 TBD - TO BE DETERMINED
OWNER'S NAME:
VILLA SERRA APARTMENTS
ARCHITECTIENGTNEER:
Z LICENSED CONTRACTOR'S DECLARATION
0
1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing
WU with Section 7000) of Division 3 of the Business and Professions Code, and my license is
'L in full force and effect. 4
/X <IG 2—
License CI Lic. N 6
p Dater (Z rrE Contractor
� ARCHffEC1'S DECLA A770N
I understand my plans shall be used as public records
U
F- Licensed Professional
y
< OWNER -BUILDER DECLARATION
� I hereby alTinm that I am exempt from the Contractor's License Law for the
o following reason. (Section 7031.5, Business and Professions Code: Any city or county
which requires a permit to construct, alter, improve- demolish, or repair any structure
y prior to its issuance, also requires the applicant for such permit to file a signed statement
< that he is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9
c
$ (commencing with Section 7000) of Division 3 of tire Business and Professions Coder) or
.. that be is exempt therefrom and the basis for the alleged exemption. Any violation of
Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of
not more than five hundred dollars (S5W).
❑ 1, as owner of the property, or my employees with wages as their sole compensation,
will do the work and the structure is not intended or offered for sale (Sec. 7044. Business
and Professions Code The Contractors License Law does not apply to an owner of
property who builds or improves thereon, and who does such work himself or through his
own employees, provided that such improvements are not intended or offered for sale. If,
however, the building or improvement is sold within one year of completion, the owner -
builder will have the burden of proving that he did not build or improve for purpose of
sale.).
❑ 1, as owner of the property. am exclusively contracting with licensed contractors to
concoct the project (Sec. 7044. Business and Professions Code:) The Contractor's Li -
cc rse Law does not apply to an owner of property who builds or improves thereon, and
who contracts for such projects with a contractor(s) licensed pursuant to the Contractors
License Law.
❑ 1 am exempt under Sec . B & P C for this mason
Owner Date
WORKERS COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of die following declarations:
1 have and will maintain a Certificate of Consent to self -insure for Workers Compen-
sation, as provided for by Section 3700 of the Labor Code, for the performance of the
work for which this permit is issued.
❑ 1 have and will maintain Workers Compensation Insurance, as required by Section
3700 of the Labor Code, for the performance of the work for which this permit is issued.
My Workers Compensation Insurance carrier and Policy number am:
Cartier, it CJt A06 6 O'f OE Policy No.: —12&A a+ 160
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
(This section need not be completed if the permit is for onc hundred dollars ($100)
or less.)
1 cenify that in the performance of the work for which this permit is issued, 1 shall not
employ any person in any manner so as to become subject to the Worken' Compensation
Laws of California. Date
Applicant
NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should
become subject to the Worker's Compensation provisions of the Labor Code- you must
Z forthwith comply with such provisions or this permit shall be deemed revoked.
0
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of
> the work for which this permit is issued (Sec. 3097, Civ. C.)
Q Lenders Name
Z L.cndeesAddress
0 I certify that I have read this application and state that the above information is
'-' correct- I agree to comply with Al city and county ordinances and state laws relating to
Ubuilding concoction, and hereby authorize representatives of this city to enter upon the
(11 above -mentioned property for inspection purposes.
LL (We) agree to save, indemnify and keep harmless the City of Cupertino against
C/] liabilities, judgments, costs and expenses which may in any way accrue against said City
Z in consequence of the granting of this permit,
APPLICANT UNDERSTANDS AND WILL. COMPLY WITH ALL NON -POINT
SOURCE REGULATIONS.
Signature of Applicant/Contractor Date
HAZARDOUS MATERIALS DISCLOSURE
Will the applicant or future building occupant store or handle hazardous material
as defined by the Cupertino Municipal Code, Chapter 9.12, and the Health and Safety
Code. Section 25532(a)?
❑ Yes xNo
Will the applicant or future building occupant use equipment or devices which
emit hazardous air contaminants as defined by the Bay Area Air Quality Management
District?
❑ Yes *0
I have mad the hazardous materials requirements under Chapter 6.95 of the Califor-
nia Health & Safety Code, Sections 25505.25533 and 25534.1 understand that if the building
does not currently have a tenant. that it is my responsibility to notify the occupant of the
requirements which must be met prior to issuance of a Certificate of Occupancy.
Owner or authorized agent Date
PERMIT NO.
07040070
PERMIT ISSUE DATE
05/31/2007
SANITARY NO. CONTROL NO.
BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
Job Description
REPAIR & REPLACE DECK SURFACE & PLYWOOD MINOR
STRUCTURAL -STARTED JOB W/OUT PERMIT -DOUBLE
FEES -CONTRACTOR PRO -CRAFT HAS BUS LIC #28938.
Ft. Floor Area
32609056 py Number
Required Inspections
Issued by:
Re -roofs
Type of Roof
Valuation
Occupancy Type
Date _^ 'i ( '0`)
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
all new materials for inspection.
Signature of Applicant Date
All roof coverings to be Class "B" or better